Physicians' second opinions influenced by the first opinion

A new study by Ben-Gurion University of the Negev (BGU) researchers indicates that physicians who give second opinions may be influenced by the first opinion and other external factors.

In the study, the researchers presented hypothetical scenarios with no clear cut clinical answers to a national sample of orthopedic surgeons and neurologists. Some were told that the patients had previously received treatment recommendations, but were not told what they were, while others were told the first opinion. One group was informed that after each gave his or her opinion, the patient would be seeking an additional opinion from another doctor.

When the orthopedic surgeons knew that the first doctor had recommended a more interventional treatment, the doctor giving the second opinion was more likely to recommend one too. However, when those same doctors were informed that their patients would seek another opinion, the orthopedic surgeons were more likely to recommend more conservative treatment instead, such as physiotherapy.

According to BGU Prof. Joseph Pliskin, the Sidney Liswood Chair in Health Care Management, "In addition to the quantitative study, personal in-depth interviews with 35 orthopedic surgeons and neurologists found that they generally had a positive view of second opinions, and even encouraged patients to seek them. But second opinions also involve difficulties in patient-doctor relationships, and among specialists themselves. It is difficult for patients to choose what to do when several doctors offer conflicting advice."

Specialists interviewed also noted the tension between public and private medicine, urban and periphery accessibility, as well as family and religious leaders' involvement when seeking a second opinion, and the legal and economic aspects of second opinions. Prof. Pliskin recommends that patients seek an alternate opinion when they hesitate to take the advice of their own physician.

The study was presented at several international meetings in Prague, Austria, Toronto and Israel.